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18 results

  • 1 - Imaging the chest
  • Edited by Richard Hopkins, Carol Peden, Sanjay Gandhi, University of Bristol
  • Book: Radiology for Anaesthesia and Intensive Care
  • Published online: 19 February 2010
  • Print publication: 08 October 2009, pp 1-58
  • View extract

    Summary

    Reading a chest X-ray requires a methodical approach that can be applied to all films so that abnormalities are not overlooked. A lateral X-ray is used to localize lesions in the AP dimension, locate lesions behind the left side of the heart. At its simplest, a chest X-ray abnormality can be classified into increased or decreased density. The chest X-rays show hazy bilateral opacification sparing the lung bases and apices. The films taken in inspiration and expiration can give clue about an inhaled foreign body during diagnosis. In cases of elevated pulmonary venous pressure, different X-ray signs develop progressively as it rises. The chest X-ray may be normal in pulmonary embolism or may demonstrate non-specific abnormalities such as linear atelectasis, small pleural effusion and elevated hemidiaphragm. Computed tomography (CT) is more sensitive than chest X-ray in the detection of complications, such as pleural effusion and pneumothorax.
  • 3 - Trauma radiology
  • Edited by Richard Hopkins, Carol Peden, Sanjay Gandhi, University of Bristol
  • Book: Radiology for Anaesthesia and Intensive Care
  • Published online: 19 February 2010
  • Print publication: 08 October 2009, pp 96-128
  • View extract

    Summary

    Rapid assessment, diagnosis and treatment are essential as aortic injury is an unstable condition. Most patients are initially imaged with plain film radiography followed by computed tomography (CT) or angiography depending on initial radiographic findings and the spectrum of other injuries. Numerous signs on the chest X-ray have been described in association with traumatic aortic injury. Chest X-rays may detect potentially life-threatening injuries that require treatment, and pelvic films may demonstrate fractures of the pelvis that indicate the need for early blood transfusion. The chest X-ray or CT for blunt trauma can be divided into systems for the purposes of ensuring that all areas are looked at. The spleen is the most commonly injured organ in the abdomen, either the result of blunt abdominal trauma or penetrating injury. Ultrasound can demonstrate splenic laceration, adjacent fluid or splenic haematoma, but the technique is often limited by pain and patient immobility.
Radiology for Anaesthesia and Intensive Care
  • Radiology for Anaesthesia and Intensive Care
  • 2nd edition
  • Edited by Richard Hopkins, Carol Peden, Sanjay Gandhi
  • Published online: 19 February 2010
  • Print publication: 08 October 2009
  • View description
    The advent of small, affordable ultrasound machines and the widespread use of PACS systems have made imaging more accessible to anaesthetists and intensivists than ever before. This concise, highly illustrated text discusses the key aspects of radiology, examining all imaging modalities and body regions. Introductory sections review the imaging knowledge required for the FRCA exams and the role of imaging in the Pre-Operative Assessment. These are followed by chapters on each imaging modality and body region, each containing numerous illustrations, practical advice on diagnosis, and many case illustrations. Each modality chapter contains a concise introductory section on the principles of image formation. Containing over 300 scans and illustrations, and written by a multidisciplinary team of radiologists and anaesthetists, Radiology for Anaesthesia and Intensive Care, second edition, is an invaluable aid for all anaesthetists and intensivists.
  • 6 - Anaesthesia in the radiology department. MRI and interventional radiology
  • Edited by Richard Hopkins, Carol Peden, Sanjay Gandhi, University of Bristol
  • Book: Radiology for Anaesthesia and Intensive Care
  • Published online: 19 February 2010
  • Print publication: 08 October 2009, pp 209-249
  • View extract

    Summary

    The anaesthetist is most commonly involved in the management of patients having computerized tomography (CT) or magnetic resonance imaging (MRI) investigations. There are many articles discussing the relative merits of anaesthesia or sedation for radiological investigations, and many different sedative and anaesthetic techniques have been used. MRI is a rapidly expanding field within radiology and new applications are constantly being found for this imaging modality. All MRI units operate certain patient and personnel exclusions because of the risks of ferromagnetic attraction. Anaesthesia can be maintained with a volatile agent or intravenously. MRI shows much greater detail of the central nervous system than CT. Anaesthesia and monitoring in the MRI suite need to be maintained to the same standards as expected in the operating theatre. The magnetic, RF and gradient fields may cause artefact interference with monitoring devices, especially ECG and pulse oximetry.
  • Chapter 5 - CT head
  • Edited by Richard Hopkins, Carol Peden, Sanjay Gandhi, University of Bristol
  • Book: Radiology for Anaesthesia and Intensive Care
  • Published online: 19 February 2010
  • Print publication: 08 October 2009, pp 172-208
  • View extract

    Summary

    All computed tomography (CT) scanners use X-rays to produce anatomical images; however, there have been enormous developments over the years in how this is achieved. The broad principle of CT scanning has remained unchanged over the years, but technological advances have been accompanied by changes in the algorithms used. Intravenous contrast used in CT is an iodine-based substance similar to that used for intravenous urograms (IVUs) and numerous other radiological procedures such as angiography. CT scans of the head are usually presented on brain windows, but are also frequently presented on bone windows, particularly in the context of trauma. After the CT scan, the patient should be kept intubated and ventilated, and returned to an intensive therapy area while the case is discussed with the local neurosurgeons. An entirely normal unenhanced CT scan of the brain is not sufficient to completely exclude intracranial metastatic disease.
  • 7 - Ultrasound
  • Edited by Richard Hopkins, Carol Peden, Sanjay Gandhi, University of Bristol
  • Book: Radiology for Anaesthesia and Intensive Care
  • Published online: 19 February 2010
  • Print publication: 08 October 2009, pp 250-304
  • View extract

    Summary

    Ultrasound is an imaging xof sound waves, which are transmitted into the body and are then reflected, back again from the structures being examined. Every ultrasound image is composed of a discrete number of lines of echo data placed side by side to appear continuous. Ultrasound imaging has a huge variety of applications for patients on intensive care units. Ultrasound can be used to guide an extremely wide range of procedures including guided central line insertion, pleural aspiration, regional anaesthesia, marking sites for safe insertion of chest drains, solid organ or tumour biopsy and various abdominal work. The best reflection from the shaft of an interventional needle is obtained when it is perpendicular to the direction of the ultrasound beam. Medical ultrasound has been used for more than 40 years, but its use in anaesthesia has only developed recently.
  • 4 - The cervical spine
  • Edited by Richard Hopkins, Carol Peden, Sanjay Gandhi, University of Bristol
  • Book: Radiology for Anaesthesia and Intensive Care
  • Published online: 19 February 2010
  • Print publication: 08 October 2009, pp 129-171
  • View extract

    Summary

    The cervical spine has been traditionally divided into an upper segment and a lower segment comprising C3-C7. There is diversity of opinion regarding the initial imaging of a patient suspected of having a cervical spine injury. The lateral radiograph is the single most important component in the radiographic assessment of the acutely injured cervical spine. The lateral view of the upper cervical spine and lower part of the skull is an important area in evaluating vertical subluxation of the odontoid process into the foramen magnum. The most common level of the cervical spine to be involved by cervical spondylosis is the C5/C6 disc space level, and this is most commonly seen in middle-aged people and beyond. Certain conditions that affect the craniocervical junction and cervical spine are clinically relevant to anaesthetists. Cervical spine injuries occur in 2%-5% of blunt trauma patients and of these 7%-14% are unstable.
  • Chapter 2 - Imaging the abdomen
  • Edited by Richard Hopkins, Carol Peden, Sanjay Gandhi, University of Bristol
  • Book: Radiology for Anaesthesia and Intensive Care
  • Published online: 19 February 2010
  • Print publication: 08 October 2009, pp 59-95
  • View extract

    Summary

    Abdominal X-ray interpretation depends upon the assessment of the bowel gas pattern, solid organ outlines, a search for abnormal calcification and a review of the skeleton. The erect X-ray shows multiple dilated gas-filled loops of bowel with several air-fluid levels. Computed tomography (CT) is the imaging investigation of choice for patients with suspected small bowel obstruction (SBO). Ultrasound has high specificity in diagnosing appendicitis, but it is operator dependent. Ultrasound is frequently used to investigate patients with acute abdominal pain, but overlying bowel gas often limits the ability to visualize the entire pancreatic gland. CT has good specificity in diagnosing pancreatitis, although in up to one-third of patients with acute pancreatitis, no detectable change in the size or appearance of the pancreas is evident. Early identification of patients with potentially severe acute pancreatitis is important, as patients with delayed transfer to intensive care units have higher mortality.